Author Archives: henrykotula

Romney calls for hazard pay for workers on the front line of the pandemic

Posted on by • Posted in 2020 Election Issues, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Stimulus, Employee Hazard Pay, Employee Protections, Essential Businesses, Essential Workers, Health Policy, Infection Control, Infectious Virus, Pandemic, Unemployment, Unemployment Insurance • Leave a comment

https://www.washingtonpost.com/politics/romney-calls-for-hazard-pay-for-workers-on-the-front-line-of-the-pandemic/2020/05/01/837e7f60-8bc9-11ea-9759-6d20ba0f2c0e_story.html?fbclid=IwAR0F49gAgZIUilmAmMk4vfElLbG4EVAiFz94E6W41DkniFVs9MIn7XJITcI&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

Why Workers Are Asking for Hazard Pay

Sen. Mitt Romney is proposing a plan to better compensate health-care workers, grocery store employees and other essential personnel working through the coronavirus pandemic as the issue of hazard pay becomes a growing flash point in the next round of emergency relief negotiations.

Romney (R-Utah), the GOP’s 2012 presidential nominee, wants to boost the pay of qualifying essential workers by up to $12 per hour for the next three months, a bonus that could be as much as $1,920 a month.

“This is a proposal which I think is fiscally responsible but also recognizes the additional risk that people are taking,” Romney said in a phone interview with The Washington Post on Friday.

He noted that an essential worker who earns less than $22 per hour may ultimately be paid less than someone earning unemployment benefits that were bolstered by Congress in recent virus rescue packages.

“That’s not fair, number one,” Romney said. “And number two, it would create an anomaly, of course, for people to be taking additional risk of their health and have someone else not working making more than they are.”

The idea of hazard pay — additional compensation for those on the front lines of the pandemic — has broad conceptual support in Washington, yet neither lawmakers nor the Trump administration addressed the issue in the economic and health relief bill, totaling nearly $3 trillion, passed thus far.

President Trump has spoken in general terms about providing additional pay to critical medical personnel, and the White House has indicated that the administration is working with Congress on doing so. Senate Democrats have released a plan, dubbed the “Heroes Fund,” that provides up to $25,000 per person for a broad category of essential personnel including not just health-care employees but also food workers and delivery drivers.

Romney’s proposal covers a similarly broad swath of workers. The Labor Department and Congress would determine what industries would be deemed “essential,” but they would include at a minimum hospitals, food distributors and manufacturers. Employers would have to prove that workers would be in conditions that increased their exposure to the coronavirus to qualify for the bonus.

Three-quarters of that additional money would be paid for by the federal government in the form of a refundable payroll tax credit, and the rest would be picked up by their employer. That pay boost would last from May 1 through July 31 under Romney’s plan.

Someone earning $50,000 or less per year would receive an additional $12 per hour, with the hourly increase gradually phased out as salaries increase. The maximum qualifying salary would be $90,000.

Romney, a former Massachusetts governor with a lengthy business background, has spoken to other GOP senators and said that while opinions may differ, the concept of hazard pay could be gaining traction among Republicans.

“It strikes me that we’re open to considering a wide array of opportunities to help people that are serving the public,” Romney said. “And a number of individuals have expressed an openness to considering different ideas.”

 

 

 

Why summer likely won’t save us from the coronavirus

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infectious Virus, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

https://www.vox.com/2020/4/29/21231906/coronavirus-pandemic-summer-weather-heat-humidity-uv-light

Summer weather could help slow the coronavirus. But it’s likely not enough.

Some Americans are hoping for a natural reprieve to social distancing as the coronavirus pandemic drags on: that sunnier, warmer, and more humid weather in the summer will destroy the Covid-19 virus — as it does with other viruses, like the flu — and let everyone go back to normal.

There is some evidence that heat, humidity, and ultraviolet light could hurt the coronavirus — an idea that President Donald Trump bizarrely leaned into when he suggested the use of “ultraviolet or just very powerful light … inside the body” to treat people sickened by Covid-19 (an idea with no scientific merit, as experts have repeatedly stated).

But even if heat, humidity, and light help slow the virus’s spread, sunny, hot, and humid weather alone won’t be enough to end the epidemic. Experts point to the examples of Singapore, Ecuador, and Louisiana, all of which have recently had growing numbers of Covid-19 cases despite temperatures hitting 80-plus degrees Fahrenheit and humidity levels reaching more than 60, 70, or even 80 percent.

High levels of heat, UV light, and humidity can help prevent more widespread infections of the flu or colds in the summer, along with medical treatments and vaccines (when available). But the Covid-19 coronavirus is still new to humans, so we don’t have as much immune protection built up against it — so the virus seems able to overcome summer-like weather and still cause big outbreaks.

“For the novel coronavirus SARS-CoV-2, we have reason to expect that like other betacoronaviruses, it may transmit somewhat more efficiently in winter than summer, though we don’t know the mechanism(s) responsible,” Marc Lipsitch, an epidemiologist at Harvard, wrote. “The size of the change is expected to be modest, and not enough to stop transmission on its own.”

Still, the studies on heat, light, and humidity, plus the fact coronavirus has a harder time spreading in open-air areas, suggest that the outdoors may be a safe target for a slow reopening as transmission of the virus slows, as long as precautions like physical distancing and mask-wearing are followed. So outdoor activities could offer a respite to lockdowns and quarantines — one that’s also, potentially, good for physical and mental health.

It also means that if Covid-19 becomes endemic (a disease that regularly comes back, like the flu or common cold), then heat, sunlight, and humidity could restrict bigger outbreaks to fall and winter. But that possibility is likely still years away, experts say.

So summer weather may make the outdoors a little safer, but it won’t be enough to quash coronavirus on its own. That means we’ll likely need to continue social distancing to some degree in the coming months, and continue working on getting more testing, aggressive contact tracing, and medical treatments up to scale before places can safely reopen their economies.

Hotter, more humid weather does seem to hurt the coronavirus

There are a few ways that summer weather could have an effect on SARS-CoV-2. Higher temperatures can help weaken the novel coronavirus’s outer lipid layer, similar to how fat melts in greater heat. Humidity in the air can effectively catch virus-containing droplets that people breathe out, causing these droplets to fall to the ground instead of reaching another human host — making humidity a shield against infection. UV light, which there’s a lot more of during sunny summer days, is a well-known disinfectant that effectively fries cells and viruses.

“There are multiple coronaviruses out there that affect our population, and many of them, if not most of them, exhibit a seasonal influence,” Mauricio Santillana, the director of the Machine Intelligence Lab at Boston Children’s Hospital and a researcher on the effects of the weather on coronavirus, told me. “The hypothesis postulated for Covid-19 is that it will have a similar behavior.”

But that’s hypothetical. How does it play out in reality?

So far, the coronavirus has largely spread in the Northern Hemisphere, where it’s been winter and early spring. It’s not clear if the weather is a reason for that, because data on its spread in the Southern Hemisphere — particularly poorer countries in Africa and South America — is largely lacking due to weak public health infrastructure.

Still, we have some evidence. The National Academies of Sciences, Engineering, and Medicine — one of America’s top scientific evidence reviewers — summarized the research earlier in April. It looked at two kinds of studies: those that tested the effects of summer-like temperatures in a laboratory, and those that attempted to tease out the effects of heat, UV light, and humidity in the real world.

In the lab, researchers use sophisticated tools to see how the virus fares in different conditions. Generally, they’ve found more heat, UV light, and humidity seem to weaken the coronavirus — although one preliminary study suggested that coronavirus may fare better in the more summer-like conditions than the flu, SARS, and monkeypox viruses.

This is the kind of study Bill Bryan, the undersecretary for science and technology at the Department of Homeland Security, presented at the April 23 White House press briefing. That study found that coronavirus seemed to die off much more quickly in hotter, more humid environments with a lot of UV light.

As the National Academies noted, however, this evidence comes with big caveats. Perhaps most importantly, these studies haven’t yet been peer reviewed. So they could have big methodological errors that we just don’t know about yet. (This Wired article does a good job breaking down the concerns with such early research.)

But even if these studies are well-conducted, the real world is simply a lot messier than a laboratory setting. For example, the lab-grown virus used in these studies may act at least somewhat differently than the natural virus in the real world.

People can also act differently in summer than they do in winter, and the lab studies don’t account for how those behaviors affect coronavirus’s spread. People are more likely to stay indoors during the winter to avoid the cold — but indoor spaces are generally more poorly ventilated and cramped, both of which make it easier for the coronavirus to spread. Warmth and sunshine also could impact the immune system, though that relationship is still unclear.

We’ll get more evidence on real-life seasonal effects as the months go by — especially if more places take potentially dangerous risks. “In Georgia, where they are opening back up without really any concrete measures to encourage distancing, we might be able to better evaluate how [the coronavirus] spreads in the summer months,” Angela Rasmussen, a virologist at Columbia, told me.

But there is some early real-world research already, which the National Academies also reviewed. These studies looked at whether the SARS-CoV-2 virus was affected by different climates in real-world settings, and if it spread more easily in places where it was colder and less humid and there was less UV light. Some researchers also developed models based on data from different outbreaks in different parts of the world.

One upcoming study from a group of researchers at the University of Nebraska Medical Center tried to model the effects of heat, humidity, and UV light, finding that they mitigated the spread of the virus. UV light seemed to play a bigger role, although the researchers cautioned that their findings will need to be replicated and verified with, ideally, years of data. “This is a very new virus, and there are lots of things we don’t know about it,” Azar Abadi, one of the researchers, told me.

But this aligns with the evidence that the National Academies reviewed.

“There is some evidence to suggest that SARS-CoV-2 may transmit less efficiently in environments with higher ambient temperature and humidity,” Harvey Fineberg, author of the National Academies report, wrote. “[H]owever, given the lack of host immunity globally, this reduction in transmission efficiency may not lead to a significant reduction in disease spread without the concomitant adoption of major public health interventions.”

Heat and humidity won’t be enough to beat the pandemic — far from it

This is the point experts emphasized again and again: It’s one thing for the weather to have some sort of effect on coronavirus; it’s another thing for that effect to be enough to actually halt the virus’s widespread transmission. We have early evidence the weather has an effect, but we also have early evidence that it won’t be enough.

The problem: Other factors, besides the weather, play a role in the spread of diseases. In the case of coronavirus, these other factors seem to play a much bigger role than weather.

The mayor of Guayaquil, Ecuador, where it’s regularly 80-plus degrees Fahrenheit, described her city’s experience with Covid-19 “like the horror of war” and “an unexpected bomb falling on a peaceful town.” Ecuador now has one of the worst coronavirus death tolls in the world — a sign that warm, sunny, and humid weather can’t make up for struggling public health infrastructure in a still-developing country.

Singapore, which is nearly on the equator, managed to contain coronavirus at first, but it has seen a growing outbreak recently. The problem, it seems, is the government neglected migrant workers in its initial response — letting Covid-19 spread in the cramped and sometimes unsanitary conditions many migrants live in. Warm, humid weather alone wasn’t enough to overcome preexisting issues and an overly narrow public policy response.

Meanwhile, Louisiana is suffering a significant coronavirus outbreak, with the fifth-most deaths per 100,000 people out of all the states. According to experts, Mardi Gras — held on February 25 — may have accelerated that. The massive celebration seemed to cause a lot of transmission, even as New Orleans saw temperatures up to the 70s, and cases continued to climb even as temperatures reached the 80s. Maybe the weather made things better than they would be otherwise, but it was, again, no match for human behavior’s effects on the spread of Covid-19.

The bigger problem is too many people in the US are still vulnerable to the virus. “While we see some influence [of the weather], the effect that we’re seeing — if there’s any effect — is eclipsed by the high levels of susceptibility in the population,” Santillana said. “Most people are still highly susceptible. So even if temperature or humidity could play a role, there’s not enough immunity.”

That made it extremely easy for the virus to spread, regardless of the weather, especially since SARS-CoV-2 appears to be so contagious relative to other pathogens. In contrast, if you think about the viruses that are more affected by the seasons — the flu and colds — humans have been dealing with them for hundreds if not thousands of years. That’s let us build some population-level protection that we just don’t have for Covid-19, making other factors besides our actions, like the weather, a bit more important for the seasonal viruses.

So down the line, if Covid-19 becomes endemic — a possibility if, for example, immunity to it isn’t as permanent as we’d like — it’s possible that seasons will have a much stronger sway over when it pops up again.

Even then, it’s worth acknowledging that seasons don’t fully determine when the flu and colds hit. As the National Academies pointed out, some flu pandemics have started in the summer: “There have been 10 influenza pandemics in the past 250-plus years — two started in the northern hemisphere winter, three in the spring, two in the summer and three in the fall.”

In fact, some of this research could be taken to mean that coronavirus will be even more dangerous eventually: If the colder, dryer weather this fall and winter empowers the virus, that could lead to a bigger outbreak. The National Academies noted, as an example, that a second spike is typical for flu pandemics: “All had a peak second wave approximately six months after emergence of the virus in the human population, regardless of when the initial introduction occurred.”

But, as is true in the reverse, other factors besides the weather likely play a bigger role in the spread. So if governments and the public do the right thing through the fall and winter, there’s still a good chance that there won’t be a big spike.

Americans will likely be social distancing through the summer

The upshot of all of this: The changing weather likely won’t be enough on its own to relax social distancing. Given that there’s still a lot about Covid-19 we still need to learn, experts don’t know this for certain. But it’s what they suspect, based on the data that we’ve seen in the research and real world so far.

“If the only concern is the health of people, it’s irresponsible to go back to relaxing social distancing anytime soon,” Santillana said. “We’re not done, even if summer starts.”

So as the plans to end social distancing indicate, the world will likely need at least some level of social distancing until a vaccine or a similarly effective medical treatment is developed, which is possibly a year or more away. That may not require the full lockdown that several states are seeing today, but it will mean restrictions on larger gatherings and some travel, while perhaps continuing remote learning and work.

Weather could help determine how safe it is to go outside, even as social distancing continues. Some states, for example, are considering opening parks and beaches during the earlier phases of reopening their economies. Experts warn that summer weather won’t allow large gatherings — 50 people or more is often cited as way too many — but it could give people some assurance that they can go outdoors as long as they keep 6 feet or more of distance from others they don’t live with, avoid touching surfaces and their faces, and wear masks.

Otherwise, however, how much social distancing will be relaxed in the coming months won’t come down to the weather but likely how much the US improves its testing and surveillance capacity. Testing gives officials the means to isolate sick people, track and quarantine the people whom those verified to be sick came into close contact with (a.k.a. contact tracing), and deploy community-wide efforts if a new cluster of cases is too large and uncontrolled otherwise.

While the US has seen some gains in testing, the number of new tests a day still fall below estimates of what’s needed (500,000 on the low end and tens of millions on the high end) to safely ease social distancing.

Along with testing, America will need aggressive contact tracing, as countries like South Korea and Germany have done, to control its outbreak. A report from the Johns Hopkins Center for Health Security and Association of State and Territorial Health estimated the US will need to hire 100,000 contact tracers — far above what states and federal officials have so far said they’re hiring. A phone app could help mitigate the need for quite as many tracers, but it’s unclear if Americans have the appetite for an app that will effectively track their every move.

These are, really, the things everyone has been hearing about the entire time during this pandemic. It’s just worth emphasizing that the summer weather likely won’t be enough on its own to mitigate the need for these other public health strategies.

“The best-case scenario is if we’re doing that [social distancing] and there’s a dampening [in the summer], maybe there is a possibility of limiting this virus here in the United States and other places,” Jesse Bell, one of the University of Nebraska Medical Center researchers, told me. “But then again we just don’t know.”

So we’re very likely going to need social distancing, testing, and contact tracing for the foreseeable future, regardless of how warm, sunny, and humid it is outside.

 

 

 

 

Molina readies for ‘significant’ Medicaid member bump as more lose jobs

Posted on by • Posted in ACA, Coronavirus, Employer-Based Health Insurance, Health Insurance Coverage Adequacy, Health Insurance Industry, Medicaid, Medical Loss Ratio (MLR), Mergers & Acquisitions, Net Income, Undermining, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://www.healthcaredive.com/news/molina-readies-for-significant-medicaid-member-bump-as-more-lose-jobs/577191/

Molina Healthcare's purchase of Medicaid managed care provider ...

Dive Brief:

  • Molina executives said it will likely experience a “significant” increase of Medicaid and exchange members as the pandemic continues to wash over the country and forces more out of work and job-based coverage, according to comments made during Friday’s first quarter earnings call.   
  • The company reaffirmed its 2020 earnings outlook with “enhanced confidence” given the “net-positive” effects likely to stem from the impact of novel coronavirus, as executives noted a steep decline in elective procedures and utilization very late in March and the limited impact COVID-19 has had on costs so far.
  • Overall for the first quarter, Molina beat Wall Street expectations on earnings per share and revenue which increased to $4.5 billion. Yet, it was only one of two managed care organizations to miss on medical loss ratio targets, which increased to 86.3% due to higher costs in its marketplace business. 

Dive Insight:

Another 3.8 million Americans filed for unemployment last week, bringing the total of out-of-work Americans to more than 30 million since the outbreak unfolded.

That presents an opportunity for insurers like Molina that are primarily positioned in Medicaid and Affordable Care Act exchange lines of business. Medicaid coverage is based on income and reserved for low-income Americans and the marketplace, or exchanges, tie coverage to income and financial help for those with incomes below a certain threshold.

Although its membership is likely to swell due to current economic conditions, Molina CEO Joe Zubretsky cautioned investors Friday by saying, “by how much we do not yet know.”

Zubretsky said Medicaid has proven it’s a stress-tested model that works in both robust economies and those in a recession.

So far, through April 27, 950 of Molina’s members have been hospitalized with COVID-19, a small fraction of Molina’s 3.4 million membership base. The average length of stay was about 10 days for these members, but they have not been able to assess the costs per episode yet, executives said Friday.

Its plans in Washington, California and Michigan were most affected. However, its Michigan plans have experienced the highest number of cases. 

By business line, Medicare members have experienced the highest percentage of COVID-19 diagnoses followed by Medicaid and marketplace members, in line with reports of the disease disproportionately affecting older Americans.

Molina also said it had entered into a definitive agreement to acquire Magellan Complete Care for $820 million in cash. The deal is expected to close in the first quarter of 2021. The deal gives Molina about 155,000 more members. Last year, Magellan generated more than $2.7 billion in revenue, according to Molina.

Magellan operates in six states, three of which would be new for Molina, including Arizona, Virginia and Massachusetts. 

 

 

 

 

COVID-19 cases are rising in rural America, and its hospitals may be unprepared

Posted on by • Posted in Coronavirus, Crisis, Crisis Management, Financially Distressed, Hospital, Medicaid, Medicaid Childrens Health Insurance Program (CHIP), Mortality, Pandemic, Public Health, Public Safety, Rural Health, Rural Hospital, Social Distancing • Leave a comment

https://www.healthcaredive.com/news/covid-19-cases-are-rising-in-rural-america-and-its-hospitals-may-be-unprep/577161/

CMS announces Rural Health Strategy | SDAHO

Dive Brief:

  • Though metro and rural areas have had different infection rates since the outbreak began, the mortality rate from the virus is mostly the same in the U.S. But in recent weeks, the infection rate in rural counties has been outpacing urban counties, according to a new analysis of COVID-19 data by the Kaiser Family Foundation.
  • According to KFF, counties with large metro areas have had nearly three times as many coronavirus cases and deaths as rural counties (327.5 cases per 100,000 versus 114.9 per 100,000, even adjusting for population size). Metro counties have also experienced nearly four times as many deaths as of last Monday (17 per 100,000 versus 4.4 per 100,000).
  • Nevertheless, the COVID-19 mortality rate is 4.2% for metro populations, versus 3.8% for rural populations. And the county with the most deaths per capita is in a non-metro area. 

Dive Insight:

The divide between rural and urban America was highlighted during the first several weeks of the COVID-19 pandemic in the U.S., as major metropolitan areas were hit much harder than their rural counterparts, suggesting lower population density could spare rural America the brunt of the outbreak.

However, this week’s KFF analysis suggests COVID-19 is now spreading in rural America, whose older population and smaller, often sparsely equipped hospitals may be ill-prepared to bear up against the coronavirus. That rural hospitals have been in dire financial straits for years suggests that they may not be able to marshal the resources to properly respond if they become inundated with coronavirus patients.

A recent letter from the Medicaid and CHIP Payment and Access Commission to Health and Human Services Secretary Alex Azar also suggests that hospitals with a high proportion of Medicaid and low-income patients are not getting enough emergency federal funding in response to COVID-19, a trend that could also hurt some rural hospitals.

According to the KFF analysis, there was a 45% uptick in COVID-19 cases in non-metro counties over the past week, versus 26% in metro counties. Over two weeks, cases increased 125% in non-metro counties versus 68% among their urban counterparts. And deaths are up 169% over the past two weeks in non-metro counties, versus a 113% increase in metro counties.

Meanwhile, the easing of lockdowns in states with large rural areas foretells more problems in the near-term. “Georgia has started to reopen certain businesses and allow limited dine-in at restaurants, despite some of its counties rising toward the top of this list of U.S. metro and non-metro counties with the highest numbers of COVID-19 deaths per capita,” the KFF analysis observed.

The county with the most deaths per capita in the U.S. is Randolph County, with 278 deaths per 100,000 people. Randolph is a rural county in Georgia.

 

 

 

CMS rolls back more Medicare, telehealth regs for providers working through pandemic

Posted on by • Posted in American Medical Association (AMA), Coronavirus, Diagnostic Testing, Health Policy, Health System, Hospital, Hospital Industry, Hospital Outpatient Departments, Medicaid, Medicare, Medicare ACO, Nursing Home, Occupational Therapy, Office Visit, Pharmacist, Physical Therapy, Physician, Primary Care, Speech Language Pathologists, Telemedicine, Virtual Visit • Leave a comment

https://www.healthcaredive.com/news/CMS-second-round-COVID-rollbacks/577199/

 

How Telemedicine Is Changing Healthcare

Dive Brief:

  • CMS issued a another round of sweeping regulatory rollbacks Thursday that will temporarily change how some providers care for patients and get compensated during the ongoing pandemic.
  • Practitioners such as therapists previously restricted from providing telehealth services for reimbursement can now do so, and CMS is also upping payments for telephone-only telehealth visits. Accountable care organizations also scored a major win in the Thursday rule drop, with CMS pledging they wouldn’t be dinged financially for lower-than-expected health outcomes in their patient populations from COVID-19.​
  • Other major changes are related to COVID-19 testing for Medicare and Medicaid beneficiaries. A written practitioner’s order is no longer needed for diagnostic testing for Medicare payment purposes. The agency also said it will cover serology, or antibody testing, including certain FDA-authorized tests that patients self-collect at home.

Dive Insight:

The new rules come out of the recent public health emergency declaration, building on others announced in late March and early April. This round of changes, which take effect immediately, focuses on expanding testing capacity to help reopen the U.S. economy, according to CMS, along with delivering expanded care to seniors.

Major provider lobbies the American Hospital Association and American Medical Association praised the changes, noting that Medicare patients have been canceling needed medical appointments because of physical distancing and transportation challenges.

The Trump administration, which allowed traditional Medicare to temporarily cover telehealth in March, continues to expand virtual care access. CMS is expanding the types of specialists allowed to provide telehealth services for reimbursement to include physical therapists, occupational therapists, speech language pathologists and others. In the past, only doctors, nurse practitioners, physician assistants and certain others could do so.

Earlier changes included waiving the video requirement for telehealth patients without access to interactive audio-video technology – particularly those in rural areas. CMS is increasing payments for telephone visits from a range of about $14-$41 to about $46-$110, according to the release.

The rollbacks are a “major victory for medicine that will enable physicians to care for their patients, especially their elderly patients with chronic conditions who may not have access to audio-visual technology or high-speed Internet,” the AMA said.

Michael Abrams, managing partner of Numerof & Associates, a healthcare consulting firm, said the current, rapid adoption of telehealth is an experiment, and depending on the results, waivers could eventually become permanent.

“Once you increase pricing, you almost never roll it back,” Abrams said. “If this new pricing on telehealth visits makes it more attractive, attractive enough to substitute telehealth for in-office visits, that not only lowers the cost of care, but makes it very much more accessible, particularly for those whose ability to see a physician is limited.”

In a victory for ACOs, CMS said the value-based organizations wouldn’t incur any financial penalties because of COVID-19 testing and treatment for their patient populations. Roughly 60% of ACOs said previously they were likely to drop out of their risk-based model to avoid potential losses, according to the National Association of ACOs.

CMS is also allowing ACOs to remain at the same level of risk for another year, instead of bumping them up to the next risk level. NAACOs said it was “appreciative” of the changes in a statement, though they asked for additional relief for providers in two-sided risk arrangements.

Other loosened restrictions include those on who can administer COVID-19 diagnostic tests for payment to include any healthcare professional authorized to do so under state law, including pharmacists. Medicare and Medicaid recipients can now get tested at parking lot sites operated by pharmacies and other entities for reimbursement.

Outpatient hospital services such as wound care, drug administration, and behavioral health services can now be delivered in temporary expansion locations, including parking lot tents, converted hotels or patients’ homes for reimbursement, so long as they’re temporarily designated as part of a hospital.

Hospital outpatient departments that relocate off-campus are paid at lower rates under current law, but CMS is making a temporary exception to continue paying those physicians at their standard rates.

The agency will also pay for certain partial hospitalization services – that is, individual psychotherapy, patient education, and group psychotherapy – that are delivered in temporary expansion locations, including patient homes.

CMS is also now requiring nursing homes to inform residents, their families, and representatives of COVID-19 outbreaks in their facilities.

 

 

 

What you need to know about the COVID-19 vaccine

Posted on by • Posted in Antibodies, Antigen, Clinical Research, Clinical Research Funding, Clinical Testing, Coronavirus, Crisis, Crisis Management, Efficacy, Food and Drug Administration (FDA), Health Policy, Infection Control, Infectious Virus, Pandemic, Public Health, Public Safety, Safety, Social Distancing, Vaccination, Vaccine, Vaccine DNA, Vaccine Inactivated, Vaccine Live, Vaccine RNA • 2 Comments

https://www.gatesnotes.com/Health/What-you-need-to-know-about-the-COVID-19-vaccine?WT.mc_id=20200430164943_COVID-19-vaccine_BG-FB&WT.tsrc=BGFB&linkId=87665504&fbclid=IwAR0SsBGe1GTcy-fOIXz86kImkScsdCGlRVgmDcPOgXMcaU7kdO39SyNpRSs

What you need to know about the COVID-19 vaccine | Bill Gates

Humankind has never had a more urgent task than creating broad immunity for coronavirus.

One of the questions I get asked the most these days is when the world will be able to go back to the way things were in December before the coronavirus pandemic. My answer is always the same: when we have an almost perfect drug to treat COVID-19, or when almost every person on the planet has been vaccinated against coronavirus.

The former is unlikely to happen anytime soon. We’d need a miracle treatment that was at least 95 percent effective to stop the outbreak. Most of the drug candidates right now are nowhere near that powerful. They could save a lot of lives, but they aren’t enough to get us back to normal.

Which leaves us with a vaccine.

Humankind has never had a more urgent task than creating broad immunity for coronavirus. Realistically, if we’re going to return to normal, we need to develop a safe, effective vaccine. We need to make billions of doses, we need to get them out to every part of the world, and we need all of this happen as quickly as possible.

That sounds daunting, because it is. Our foundation is the biggest funder of vaccines in the world, and this effort dwarfs anything we’ve ever worked on before. It’s going to require a global cooperative effort like the world has never seen. But I know it’ll get done. There’s simply no alternative.

Here’s what you need to know about the race to create a COVID-19 vaccine.

The world is creating this vaccine on a historically fast timeline.

Dr. Anthony Fauci has said he thinks it’ll take around eighteen months to develop a coronavirus vaccine. I agree with him, though it could be as little as 9 months or as long as two years.

Although eighteen months might sound like a long time, this would be the fastest scientists have created a new vaccine. Development usually takes around five years. Once you pick a disease to target, you have to create the vaccine and test it on animals. Then you begin testing for safety and efficacy in humans.

Safety and efficacy are the two most important goals for every vaccine. Safety is exactly what it sounds like: is the vaccine safe to give to people? Some minor side effects (like a mild fever or injection site pain) can be acceptable, but you don’t want to inoculate people with something that makes them sick.

Efficacy measures how well the vaccine protects you from getting sick. Although you’d ideally want a vaccine to have 100 percent efficacy, many don’t. For example, this year’s flu vaccine is around 45 percent effective.

To test for safety and efficacy, every vaccine goes through three phases of trials:

  • Phase one is the safety trial. A small group of healthy volunteers gets the vaccine candidate. You try out different dosages to create the strongest immune response at the lowest effective dose without serious side effects.
  • Once you’ve settled on a formula, you move onto phase two, which tells you how well the vaccine works in the people who are intended to get it. This time, hundreds of people get the vaccine. This cohort should include people of different ages and health statuses.
  • Then, in phase three, you give it to thousands of people. This is usually the longest phase, because it occurs in what’s called “natural disease conditions.” You introduce it to a large group of people who are likely already at the risk of infection by the target pathogen, and then wait and see if the vaccine reduces how many people get sick.

After the vaccine passes all three trial phases, you start building the factories to manufacture it, and it gets submitted to the WHO and various government agencies for approval.

This process works well for most vaccines, but the normal development timeline isn’t good enough right now. Every day we can cut from this process will make a huge difference to the world in terms of saving lives and reducing trillions of dollars in economic damage.

So, to speed up the process, vaccine developers are compressing the timeline. This graphic shows how:

In the traditional process, the steps are sequential to address key questions and unknowns. This can help mitigate financial risk, since creating a new vaccine is expensive. Many candidates fail, which is why companies wait to invest in the next step until they know the previous step was successful.

For COVID-19, financing development is not an issue. Governments and other organizations (including our foundation and an amazing alliance called the Coalition for Epidemic Preparedness Innovations) have made it clear they will support whatever it takes to find a vaccine. So, scientists are able to save time by doing several of the development steps at once. For example, the private sector, governments, and our foundation are going to start identifying facilities to manufacture different potential vaccines. If some of those facilities end up going unused, that’s okay. It’s a small price to pay for getting ahead on production.

Fortunately, compressing the trial timeline isn’t the only way to take a process that usually takes five years and get it done in 18 months. Another way we’re going to do that is by testing lots of different approaches at the same time.

There are dozens of candidates in the pipeline.

As of April 9, there are 115 different COVID-19 vaccine candidates in the development pipeline. I think that eight to ten of those look particularly promising. (Our foundation is going to keep an eye on all the others to see if we missed any that have some positive characteristics, though.)

The most promising candidates take a variety of approaches to protecting the body against COVID-19. To understand what exactly that means, it’s helpful to remember how the human immune system works.

When a disease pathogen gets into your system, your immune system responds by producing antibodies. These antibodies attach themselves to substances called antigens on the surface of the microbe, which sends a signal to your body to attack. Your immune system keeps a record of every microbe it has ever defeated, so that it can quickly recognize and destroy invaders before they make you ill.

Vaccines circumvent this whole process by teaching your body how to defeat a pathogen without ever getting sick. The two most common types—and the ones you’re probably most familiar with—are inactivated and live vaccines. Inactivated vaccines contain pathogens that have been killed. Live vaccines, on the other hand, are made of living pathogens that have been weakened (or “attenuated”). They’re highly effective but more prone to side effects than their inactivated counterparts.

Inactivated and live vaccines are what we consider “traditional” approaches. There are a number of COVID-19 vaccine candidates of both types, and for good reason: they’re well-established. We know how to test and manufacture them.

The downside is that they’re time-consuming to make. There’s a ton of material in each dose of a vaccine. Most of that material is biological, which means you have to grow it. That takes time, unfortunately.

That’s why I’m particularly excited by two new approaches that some of the candidates are taking: RNA and DNA vaccines. If one of these new approaches pans out, we’ll likely be able to get vaccines out to the whole world much faster. (For the sake of simplicity, I’m only going to explain RNA vaccines. DNA vaccines are similar, just with a different type of genetic material and method of administration.)

Our foundation—both through our own funding and through CEPI—has been supporting the development of an RNA vaccine platform for nearly a decade. We were planning to use it to make vaccines for diseases that affect the poor like malaria, but now it’s looking like one of the most promising options for COVID. The first candidate to start human trials was an RNA vaccine created by a company called Moderna.

Here’s how an RNA vaccine works: rather than injecting a pathogen’s antigen into your body, you instead give the body the genetic code needed to produce that antigen itself. When the antigens appear on the outside of your cells, your immune system attacks them—and learns how to defeat future intruders in the process. You essentially turn your body into its own vaccine manufacturing unit.

Because RNA vaccines let your body do most of the work, they don’t require much material. That makes them much faster to manufacture. There’s a catch, though: we don’t know for sure yet if RNA is a viable platform for vaccines. Since COVID would be the first RNA vaccine out of the gate, we have to prove both that the platform itself works and that it creates immunity. It’s a bit like building your computer system and your first piece of software at the same time.

Even if an RNA vaccine continues to show promise, we still must continue pursuing the other options. We don’t know yet what the COVID-19 vaccine will look like. Until we do, we have to go full steam ahead on as many approaches as possible.

It might not be a perfect vaccine yet—and that’s okay.

The smallpox vaccine is the only vaccine that’s wiped an entire disease off the face of the earth, but it’s also pretty brutal to receive. It left a scar on the arm of anyone who got it. One out of every three people had side effects bad enough to keep them home from school or work. A small—but not insignificant—number developed more serious reactions.

The smallpox vaccine was far from perfect, but it got the job done. The COVID-19 vaccine might be similar.

If we were designing the perfect vaccine, we’d want it to be completely safe and 100 percent effective. It should be a single dose that gives you lifelong protection, and it should be easy to store and transport. I hope the COVID-19 vaccine has all of those qualities, but given the timeline we’re on, it may not.

The two priorities, as I mentioned earlier, are safety and efficacy. Since we might not have time to do multi-year studies, we will have to conduct robust phase 1 safety trials and make sure we have good real-world evidence that the vaccine is completely safe to use.

We have a bit more wiggle room with efficacy. I suspect a vaccine that is at least 70 percent effective will be enough to stop the outbreak. A 60 percent effective vaccine is useable, but we might still see some localized outbreaks. Anything under 60 percent is unlikely to create enough herd immunity to stop the virus.

The big challenge will be making sure the vaccine works well in older people. The older you are, the less effective vaccines are. Your immune system—like the rest of your body—ages and is slower to recognize and attack invaders. That’s a big issue for a COVID-19 vaccine, since older people are the most vulnerable. We need to make sure they’re protected.

The shingles vaccine—which is also targeted to older people—combats this by amping up the strength of the vaccine. It’s possible we do something similar for COVID, although it might come with more side effects. Health authorities could also ask people over a certain age to get an additional dose.

Beyond safety and efficacy, there are a couple other factors to consider:

  • How many doses will it be? A vaccine you only get once is easier and quicker to deliver. But we may need a multi-dose vaccine to get enough efficacy.
  • How long does it last? Ideally, the vaccine will give you long-lasting protection. But we might end up with one that only stops you from getting sick for a couple months (like the seasonal flu vaccine, which protects you for about six months). If that happens, the short-term vaccine might be used while we work on a more durable one.
  • How do you store it? Many common vaccines are kept at 4 degrees C. That’s around the temperature of your average refrigerator, so storage and transportation is easy. But RNA vaccines need to be stored at much colder temperature—as low as -80 degrees C—which will make reaching certain parts of the world more difficult.

My hope is that the vaccine we have 18 months from now is as close to “perfect” as possible. Even if it isn’t, we will continue working to improve it. After that happens, I suspect the COVID-19 vaccine will become part of the routine newborn immunization schedule.

Once we have a vaccine, though, we still have huge problems to solve. That’s because…

We need to manufacture and distribute at least 7 billion doses of the vaccine.

In order to stop the pandemic, we need to make the vaccine available to almost every person on the planet. We’ve never delivered something to every corner of the world before. And, as I mentioned earlier, vaccines are particularly difficult to make and store.

There’s a lot we can’t figure out about manufacturing and distributing the vaccine until we know what exactly we’re working with. For example, will we be able to use existing vaccine factories to make the COVID-19 vaccine?

What we can do now is build different kinds of vaccine factories to prepare. Each vaccine type requires a different kind of factory. We need to be ready with facilities that can make each type, so that we can start manufacturing the final vaccine (or vaccines) as soon as we can. This will cost billions of dollars. Governments need to quickly find a mechanism for making the funding for this available. Our foundation is currently working with CEPI, the WHO, and governments to figure out the financing.

Part of those discussions center on who will get the vaccine when. The reality is that not everyone will be able to get the vaccine at the same time. It’ll take months—or even years—to create 7 billion doses (or possibly 14 billion, if it’s a multi-dose vaccine), and we should start distributing them as soon as the first batch is ready to go.

Most people agree that health workers should get the vaccine first. But who gets it next? Older people? Teachers? Workers in essential jobs?

I think that low-income countries should be some of the first to receive it, because people will be at a much higher risk of dying in those places. COVID-19 will spread much quicker in poor countries because measures like physical distancing are harder to enact. More people have poor underlying health that makes them more vulnerable to complications, and weak health systems will make it harder for them to receive the care they need. Getting the vaccine out in low-income countries could save millions of lives. The good news is we already have an organization with expertise about how to do this in Gavi, the Vaccine Alliance.

With most vaccines, manufacturers sign a deal with the country where their factories are located, so that country gets first crack at the vaccines. It’s unclear if that’s what will happen here. I hope we find a way to get it out on an equitable basis to the whole world. The WHO and national health authorities will need to develop a distribution plan once we have a better understanding of what we’re working with.

Eventually, though, we’re going to scale this thing up so that the vaccine is available to everyone. And then, we’ll be able to get back to normal—and to hopefully make decisions that prevent us from being in this situation ever again.

It might be a bit hard to see right now, but there is a light at the end of the tunnel. We’re doing the right things to get a vaccine as quickly as possible. In the meantime, I urge you to continue following the guidelines set by your local authorities. Our ability to get through this outbreak will depend on everyone doing their part to keep each other safe.

 

 

 

Contact tracing is the next big hurdle in the push to re-open cities

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infectious Virus, Leadership Decentralized, Pandemic, Public Health, Public Safety, Social Distancing • Leave a comment

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Contact tracing is the next big hurdle in the push to re-open ...

As some states take steps to partially re-open their economies, public health officials and local governments are trying to aggressively ramp up contact tracing to track the spread of COVID-19 in their communities.

Why it matters: If we are indeed in the midst of a war against an invisible enemy, a contact-tracing offensive — launched by both an army of human tracers and an arsenal of technological tools — will be a big part of the key to winning.

  • Identifying who has come in contact with people infected with the disease is critical to isolating the coronavirus while also allowing some semblance of daily life to resume.

Between the lines: State and city budgets are being hammered by the economic fallout of COVID-19, making it harder to find the resources to hire and train people to contact trace or acquire needed technologies.

  • Some governments are recruiting volunteers, retirees and students to do the work. But the sheer number of people needed — at least 100,000 across the U.S., per Johns Hopkins — and the open-ended duration of the work makes that a very daunting task.
  • “We haven’t seen a big push coming from the federal government in either traditional contact tracing or these technology-based approaches,” said Josh Michaud, associate director for Global Health Policy at the Kaiser Family Foundation. “That leaves most of the legwork and decision-making to the states and local authorities.”

State and county public health officials are ramping up tracing efforts now that testing availability is improving — since tracing only works with widespread testing.

  • Massachusetts Gov. Charlie Baker allotted $44 million to an ambitious contact tracing program, which is training 1,000 tracers to staff a virtual call center to track people who came in close contact with those who’ve tested positive for the virus, starting from 48 hours before the symptoms emerged, per the Boston Globe.
  • Texas’ Harris County — the nation’s third-most populous county with 4.7 million people, including the city of Houston — this week approved the hire of 300 contact tracers.

“For every case, we have an average of about 20 people to contact. … So if you have 100 cases, you’ve got 2,000 contacts you’ve got to handle for that day because you know the next day you’ll have maybe another 100–150 cases.”

— Umair Shah, executive director of Harris County Public Health

What’s happening: Other countries are relying on tech to varying degrees to augment contact tracing.

  • In March, Singapore launched TraceTogether, an app that uses Bluetooth signals to help users learn whether they’ve been in contact with someone who tests positive. More than 1 million people have downloaded it, and Singapore has made it available to other countries.
  • Australia said more than a million people downloaded its Bluetooth contact tracing app, based on Singapore’s version, within hours of the government making it available.
  • South Korea used phone GPS records, credit card transactions and closed-circuit television to augment patient interviews for its contact tracing effort.
  • Iceland claims a 93% success rate of voluntary contact tracing through a smartphone app.

In the U.S., the most likely scenario for widespread, tech-enabled contact tracing lies with work done by Google and Apple.

  • The two companies are sharing an early version of what they’re calling COVID-19 exposure notification technology with certain developers working with public health authorities. Apple and Google want to release the first phase of the project, which will enable users to opt-in to Bluetooth-based contact tracing, by mid-May.
  • MIT researchers, who launched a project to perform private automated contact tracing, are using their expertise with radar to help figure out how Bluetooth can show the distance between users.
  • Marc Zissman, associate head of the Cyber Security and Information Sciences Division at MIT’s Lincoln Laboratory, said Google and Apple’s effort appears to be incorporating the privacy principles researchers have called for, including sending randomized data that is not personally identifiable.
  • “Our best guess is that when Google and Apple release this, this is going to be what it is,” Zissman said. “There was Betamax and VHS. Everybody was using Betamax. And then every company but Sony went with VHS, and that was it. And then Betamax just stopped being used. That’s kind of like what’s going to happen here I think in the United States.”

The success of the effort will depend on widespread adoption of the technology so people will be notified when they come in contact with someone who tests positive.

What to watch: Zissman said MIT researchers will reverse engineer the Google/Apple programs to ensure they are following the privacy protocols, and also expect pilot testing in limited settings like hospitals or universities before states begin implementing.

  • It may also take a public service campaign featuring trusted voices to encourage Americans to opt in.
  • “There’s a lot of doubts, one, that people’s privacy concerns can be addressed sufficiently and, two, that enough people would download the app to make it helpful and actually provide the service it’s supposed to provide,” Michaud said.

 

 

 

Employers split from health care industry

Posted on by • Posted in 2020 Election Issues, COBRA Coverage, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Stimulus, Employer-Based Health Insurance, Health Insurance Coverage Adequacy, Health Insurance Industry, Health Policy, Health System, Hospital, Hospital Bailout, Hospital Bailout Funding, Hospital Industry, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

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Employers split from health care industry over coronavirus demands ...

Several large employer groups this week refused to sign on to funding requests they consider a “handout” for hospitals and insurers, according to three people close to the process.

The big picture: Coronavirus spending bills are sharpening tensions between the employers that fund a significant portion of the country’s health care system and the hospitals, doctors and insurers that operate it, Bob reports.

Driving the news: The industry’s most recent request — written primarily by the large hospital and health insurance lobbying groups — focused on a few items for the next coronavirus legislation:

  • Providing subsidies to maintain employer-sponsored insurance, which already receives a large tax break, as well as providing subsidies for COBRA for people who have lost their jobs.
  • Increasing subsidies for Affordable Care Act plans and creating a special ACA enrollment window.
  • Opposing the use of the industry’s bailout funds to pay for uninsured COVID-19 patients at Medicare rates.

Between the lines: Employers know they get charged a lot more for health care services compared with public insurers, but many weren’t keen about urging Congress to “set up a government program to pay commercial reimbursements,” said an executive at a trade group that represents large corporations.

The other side: Several health care groups that signed the letter dismissed the idea of any disagreement with employers.

 

 

 

Why Gilead’s coronavirus drug is not a “silver bullet”

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Why Gilead's coronavirus drug is not a "silver bullet" - Axios

If you feel like you’re suffering whiplash from the new, conflicting study data on Gilead Sciences’ experimental coronavirus drug, remdesivir, you’re not alone.

The big picture: Remdesivir could provide some help and lay the groundwork for more research, but this drug on its own does not appear to be any kind of “cure” for the novel coronavirus, Axios’ Bob Herman reports.

What’s happening: Remdesivir helped coronavirus patients get out of the hospital modestly quicker, based on early reads of an important and rigorously designed trial run by the National Institutes of Health,

  • That could be encouraging for those who get sick.

Yes, but: Analysts and experts were cautious about drawing too many conclusions without the full data from NIH — especially considering the primary outcome was changed mid-trial, and a separate randomized trial concluded remdesivir does little, if anything, to combat the virus.

  • “Remdesivir is a real drug for COVID … but again, not a silver bullet,” Umer Raffat, a pharmaceutical analyst at Evercore ISI, wrote to investors on Wednesday.
  • And because the drug has limited efficacy and likely works best before the infection gets too serious, “its availability is not going to move the needle on social distancing relaxation,” tweeted Peter Bach, a physician and drug researcher at Memorial Sloan Kettering.

The bottom line: This near-constant back-and-forth over remdesivir reinforces how strong the science and data need to be for any treatment, or for the world’s best hope: a vaccine.

 

 

 

Crisis begins to hit professional and public-sector jobs once considered safe

Posted on by • Posted in 2020 Election Issues, Economic Crisis, Economy, Health Insurance Coverage Adequacy, Job, Job Market, Job Search, Job Security, Out of Pocket Expenses, Pandemic, Paycheck Protection Program, Quarantine, Social Distancing, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

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How COVID-19 Is Crashing On The Class Of 2020: Job Offers Already ...

As the novel coronavirus pandemic brought business to a halt, the pain rippled outward, blowing up sector after sector. According to a detailed analysis of unemployment claims, no industry was left untouched.

After that first chaotic week of lockdowns mid-March, as officials scrambled to slow the spread of the deadliest pandemic in more than a century, restaurants and theaters saw job losses slow while losses in other sectors, such as construction and supply-chain work, accelerated. Now, it appears the economic upheaval is hitting professional and public-sector jobs that some once regarded as safe.

The Labor Department doesn’t release jobless claims by industry. So, building on the work of economist Ben Zipperer and his colleagues at the Economic Policy Institute, we analyzed industry-specific new unemployment-benefit claims from 14 states that publish them. (For a full list, see the charts below.)

For that, we need to focus in on the weekly changes in jobless claims to distinguish between industries where claims are falling and those where claims are steady or increasing. The data can also help us estimate how the labor market will change in coming months.

Week 1, March 15 to 21: Full-contact industries

(Highest week-to-week change included: accommodation and food services; arts entertainment and recreation; hairdressers, auto mechanics and laundry workers)

The first week of closures slammed headfirst into industries that require the most face-to-face customer contact — America’s hospitality sector. More than 7 percent of all restaurant, hotel and bar workers filed for unemployment in this first week alone.

For public officials looking to enforce social distancing, bars, hotels and movie theaters were obvious targets: They’re discretionary spending and require significant human interaction. Another category, which the government calls “other services” but is primarily made up of hairdressers, auto mechanics and laundry workers, also suffered swift and significant losses.

The number of newly unemployed filers in all these high-contact industries fell off in subsequent weeks, but they remain the biggest casualties of the crisis. And unemployment claims probably understate the pain of lower-earning Americans. Low-wage workers often don’t qualify for benefits because they haven’t spent enough time on the job, or aren’t being paid enough, Zipperer said.

A survey released Tuesday by Zipperer and his colleague Elise Gould implies unemployment numbers may be significantly worse than government statistics show. For every 10 people who successfully applied for unemployment benefits during the crisis, they show, another three or four couldn’t get through the overloaded system, and two more didn’t even apply because the system is too difficult.

Week 2, March 22 to 28: The producers

(Highest week-to-week change included: manufacturing; construction; retail)

By the second week, the shutdown moved from businesses where the primary danger is interacting with customers to those, like construction and manufacturing, that require in-person interaction with large crews of colleagues.

On March 26, for example, Spokane, Wash.-area custom-cabinet maker Huntwood Industries, laid off around 500 employees, according to Thomas Clouse of the Spokesman-Review. As a manufacturer whose sales depend on the construction industry, it was hit doubly hard by the shutdowns.

“It is a scary time,” Amy Ohms, 37, told Clouse. “It’s kind of unfair. I think construction is essential. There is a lot of uncertainty.”

Manufacturers were among the first publicly traded companies to note travel and supply-chain risks related to the coronavirus outbreak in China in financial filings, according to a separate analysis by Oxford researchers Fabian Stephany and Fabian Braesemann and collaborators in Berlin. By March, manufacturers were noting domestic production issues.

Their analysis also shows that, in the middle of March, concern about the coronavirus and its disease, covid-19, from retail corporations eclipsed that of manufacturers. Indeed, retail struggled mightily in the second week of the crisis. More workers were told to stay home, and folks realized foot traffic was often incompatible with social distancing.

The retail sector wasn’t hit as quickly or as forcefully as food services or entertainment, presumably because the sector includes grocery stores and others who employ workers who were deemed essential.

Week 3, March 29 to April 4: The supply chain

(Highest week-to-week change included: wholesale trade; retail trade; administrative and waste management)

In the third week, the pain worked its way up the supply chain, as wholesale trade — a sector that includes some sales representatives, truck drivers and freight laborers — got slammed.

In theory, the lockdowns created near-perfect trucking conditions: traffic vanished, diesel keeps getting cheaper and the roads are safer than they have been in decades. Only one problem: There’s not much to haul right now.

Don Hayden, president of Louisville trucking firm M&M Cartage, feared he would have to lay off about 70 percent of his 400 employees — drivers, mechanics and office staff — in early April. Orders from his customers in heavy manufacturing evaporated.

But, just in time, he got a Payroll Protection Program loan through his local bank. He was shocked at how rapidly his loan was approved and the money arrived, and he said the Treasury Department had done an outstanding job.

“We’re good through May and into June,” he said. “We have a good workforce. We’re proud of them. We sure would like to retain them.”

At this point in the crisis, the focus shifted from huge, industry-eviscerating swings in jobless numbers to gradual weekly trends that help us guess where the jobless claims will settle in the weeks and months to come.

As industries fall like dominoes, policymakers need to realize the damage isn’t contained to a few specific sectors, said University of Tennessee economist Marianne Wanamaker, a former member of Trump’s Council of Economic Advisers.

She said there may be a temptation to extend benefits for difficult-to-reopen industries such as food service and hospitality, but “it doesn’t comport with the data because the damage is so widespread. It’s not fair to say, ‘Hotel and restaurant workers, you get these really generous packages and everybody else has to go back to work.’ ”

Week 4, April 5 to 11: White-collar workers

(Highest week-to-week change included: management; finance and insurance; public administration)

White-collar industries have been shedding jobs since mid-March, albeit at a much lower rate than lower-income sectors. But as losses in low-income sectors subsided, white-collar jobless claims stayed flat or even intensified. By week four, categories that contain managers, bookkeepers, insurance agents and bank tellers saw some of the worst weekly trends of any sector.

On April 9, the online review site Yelp laid off 1,000 workers and furloughed 1,100 more (about a third of its workforce) as traffic on the site plunged while businesses were locked down.

“The physical distancing measures and shelter-in-place orders, while critical to flatten the curve, have dealt a devastating blow to the local businesses that are core to our mission,” CEO Jeremy Stoppelman wrote at the time.

Jane Oates, president of the employment-focused nonprofit organization WorkingNation, used to oversee the Labor Department wing that coordinates unemployment claims and training. “The big difference between coronavirus and the Great Recession is that this has completely stopped the economy across so many sectors,” she said.

During the Great Recession, she and her team had the luxury of flooding support into areas that were being hit hardest in a particular week or month. They went from state to state and industry to industry, putting out fires as they arose.

The Labor Department can’t address individual problems like that during the coronavirus recession, she said, because everybody’s getting shellacked simultaneously.

Week 5, April 12 to 18: The public sector

(Highest week-to-week change included: oil, gas and mining; utilities; public administration)

In the week ending April 18, the most recent for which we have data, we can no longer avoid one of the most ominous trends in the entire analysis: a rise in public-sector layoffs. Utilities, public administration and education services — all of which have close implicit or explicit ties to state and local government, were among the worst-faring sectors on a weekly basis.

To stem the tide of what could be millions of job losses and furloughs, the National League of Cities is pushing for a $250 billion bailout of cities throughout the country, colleague Tony Romm reports.

In Broomfield, Colo., a Denver-area suburb of about 70,000 residents, 235 city and county employees were furloughed on April 22, according to Jennifer Rios in the Broomfield Enterprise.

“The impact of the COVID-19 coronavirus is more significant than any of us could have ever expected for our well-being, as well as our municipal financial stability,” Rios reports that officials wrote in a letter to furloughed employees.“

State and local governments are typically required to balance their budgets. Now that they’re staring down the barrel of a huge tax-revenue shortfall, “these revenue losses are going to cause government budgets to fall and they’re going to lay people off,” Zipperer said.

“You’re seeing the beginnings of a big contraction in the public sector,” he said. “That’s going to be the next huge thing.”

The public sector used to be the bulwark that kept the economy going while the private sector pulled back during a recession, Zipperer said. “Over the last couple of recessions, the public sector hasn’t played that traditional role,” Zipperer said. “As a result, we’ve seen steeper recessions and slower recoveries.”